| NPI | 1891161584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 35019) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040593) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2020-10-02 |