| NPI | 1245861749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 9678) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9492) |
| 1223G0001X Dentist, General Practice (Licence: SC 9492) | |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2023-01-02 |