| 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 |