| NPI | 1386165819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33203) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 060847) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2021-04-12 |