| NPI | 1043663321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34686) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001380-15) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2018-12-18 |