| NPI | 1336678499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37839) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041324) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2021-12-01 |