| NPI | 1679843866 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25559) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122409) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2021-08-04 |