| NPI | 1083100564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37229) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416150) |
| 122300000X Dentist (Licence: AZ D010251) | |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2022-07-25 |