| NPI | 1164970505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 38402) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4608) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 65248) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2026-03-12 |