| NPI | 1194350975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 42679) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: TX 20637) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2026-07-27 |