| 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 |