| NPI | 1073964763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33720) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415227) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2019-03-05 |