| NPI | 1679067045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 60183) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33600) |
| 1223G0001X Dentist, General Practice (Licence: SC 9060) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-11-17 |