| NPI | 1396005971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 35439) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19992) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2019-07-14 |