| NPI | 1659684827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25963) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 19092) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2022-12-13 |