| NPI | 1235589607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32183) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32183) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2022-01-20 |