| 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 |