| NPI | 1245857424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36485) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D14404) |
| 122300000X Dentist (Licence: VA 0401418274) | |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2024-09-03 |