| NPI | 1154939411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35176) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2020012233) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2025-08-27 |