| NPI | 1205288461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34956) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-416-16) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2022-07-18 |