| NPI | 1568709558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31469) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 7011-15) |
| Enumeration Date | 2013-01-10 |
| Last Update Date | 2020-08-04 |