| NPI | 1740601061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 85139-875) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35877) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2025-03-03 |