| NPI | 1760666465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 22582) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22582) |
| 1223G0001X Dentist, General Practice (Licence: TX 22582) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2014-02-04 |