| NPI | 1194266072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NC 12643) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8793) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2025-10-17 |