| NPI | 1649533761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NV S3-331) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6765) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2024-07-24 |