| NPI | 1194575092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 1199) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107293) |
| 122300000X Dentist (Licence: KY 11107) | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-06-12 |