| NPI | 1679950414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34875) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058567) |
| 1223G0001X Dentist, General Practice (Licence: NY 058567) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2019-05-20 |