| NPI | 1366972671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D11698) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022204) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE61337356) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-07-16 |