| NPI | 1942781414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WI 1002776-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041918) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2022-07-08 |