| NPI | 1619422904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32273) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 32273) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2021-06-24 |