| NPI | 1750980025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 36785) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122941) |
| 122300000X Dentist (Licence: TX 36785) | |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2025-08-15 |