| NPI | 1629708540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39352) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 27040) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2023-07-24 |