| NPI | 1598163974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 38049) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057687) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2023-07-20 |