| NPI | 1649886359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36659) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417164) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |