| NPI | 1124495189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31352) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 31352) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2020-07-28 |