| NPI | 1194933390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 29779) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 8372) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2022-06-07 |