| NPI | 1225804404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 18286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN2000186) |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2024-09-19 |