| NPI | 1891379830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17250) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17250) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2021-10-22 |