| NPI | 1023245909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29731) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18689) |
| 122300000X Dentist (Licence: IL 019.028499) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2021-02-18 |