| NPI | 1659800720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 32946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 7052) |
| 1223G0001X Dentist, General Practice (Licence: TX 32946) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2022-04-13 |