| NPI | 1528464781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32580) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32580) |
| 1223G0001X Dentist, General Practice (Licence: CA 63558) | |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2023-05-24 |