| NPI | 1104346816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3919-17) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-07-25 |