| NPI | 1215573522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 14185700) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: ID 1081800) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2026-09-03 |