| NPI | 1184152415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D012337) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34982) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2025-01-09 |