| NPI | 1295023513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30869) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3840) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2015-11-03 |