| NPI | 1679853873 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 27286) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2022-04-28 |