NPI | 1316112782 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 39811) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21870) |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 6360-15) | |
Enumeration Date | 2008-04-28 |
Last Update Date | 2023-07-26 |