| NPI | 1780352120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D011717) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37805) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2024-12-19 |