NPI | 1063966828 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415544) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 32148) |
Enumeration Date | 2016-08-10 |
Last Update Date | 2021-11-17 |