| NPI | 1679953459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29576) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29576) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2019-10-03 |