| NPI | 1659648541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 61059) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054801) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2014034197) | |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2023-11-20 |