| NPI | 1356014633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 39025) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401417589) |
| Enumeration Date | 2021-08-01 |
| Last Update Date | 2024-06-10 |