| NPI | 1255418588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL HAD116) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D12200) |
| 122300000X Dentist (Licence: TX 22572) | |
| 122300000X Dentist (Licence: IL 019026422) | |
| 122300000X Dentist (Licence: WI 6476015) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-08-03 |