| NPI | 1457767618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4142) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-08-27 |