| NPI | 1811254196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29556) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2012001666) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2015-09-10 |