| NPI | 1164040572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 36325) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36325) |
| Enumeration Date | 2020-07-12 |
| Last Update Date | 2023-07-12 |