| NPI | 1154766202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IA 08954) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08954) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2024-02-21 |