| NPI | 1164077327 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV S3-353C) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35469) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2021-09-21 |