| NPI | 1306418389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37121) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417301) |
| Enumeration Date | 2021-07-11 |
| Last Update Date | 2021-07-11 |