| NPI | 1497124556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 36717) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8545) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SC 8545) | |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2021-04-09 |