| NPI | 1679909121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29427) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401419216) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2025-09-05 |