NPI | 1063807873 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 28983) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4257) |
Enumeration Date | 2015-03-30 |
Last Update Date | 2015-03-30 |