| NPI | 1427693506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39254) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600324) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2023-01-27 |