| NPI | 1104380799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 36193) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3272) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2020-09-23 |