| NPI | 1912253428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 32686) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 32686) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2017-12-12 |