| NPI | 1609144997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8896) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27456) |
| 122300000X Dentist (Licence: TN 11246) | |
| 122300000X Dentist (Licence: FL 21809) | |
| 1223G0001X Dentist General Practice (Licence: TX 27456) | |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2021-10-27 |