| NPI | 1457873804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35900) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS09456) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2020-02-04 |