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 |