| NPI | 1407301740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 32254) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32254) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2025-09-04 |