| NPI | 1750807822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 107424) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6950) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 061750) | |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2022-11-26 |