| NPI | 1649689266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX 38274) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 13409) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2022-12-12 |