| NPI | 1619497062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35719) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN22701) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-04-04 |