| NPI | 1679170112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 363395) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 363395) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2021-01-20 |