| NPI | 1063073914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35296) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35296) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2026-01-21 |