| NPI | 1881158301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 4167-20) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010240) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2021-01-21 |