| NPI | 1659727238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34802) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3302) |
| 1223G0001X Dentist, General Practice (Licence: PR 3302) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2019-01-14 |