| NPI | 1346616711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 122509) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31370) |
| 1223G0001X Dentist, General Practice (Licence: TX 31370) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2022-08-19 |