| NPI | 1598772600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 20718) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 20718) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 20718) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2012-11-30 |