| NPI | 1356902712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35193) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35193) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2021-12-13 |