| NPI | 1861521015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 20594) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 20594) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |