| NPI | 1104404383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 18197) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122561) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2024-09-07 |