| NPI | 1447708151 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32177) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32177) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2020-06-12 |