| NPI | 1093242729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: OH 30.025317) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041227) |
| 122300000X Dentist (Licence: MI 2901022659) | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2024-03-14 |