| NPI | 1194106260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33812) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122415) |
| 122300000X Dentist (Licence: AZ D009262) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2021-07-10 |