| NPI | 1457394439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 19225) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: TX 19225) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2024-04-13 |