| NPI | 1073174025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 9366) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: SC 2017) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2021-07-27 |