| NPI | 1750790515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D10077) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10077) |
| 122300000X Dentist (Licence: AZ D009350) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2022-04-21 |