| NPI | 1700498821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 40176) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7645) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2024-01-30 |