| NPI | 1275290033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 064746) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY ETN898) |
| 122300000X Dentist (Licence: TX ETN898) | |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2026-01-21 |