| NPI | 1669990180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38176) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022454) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2022-11-14 |