| NPI | 1043862501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 38236) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX pending) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2022-07-20 |