| NPI | 1588178263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33574) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33574) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2023-02-28 |