| NPI | 1659857522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36849) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7495) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2021-01-20 |