| NPI | 1689058562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31125) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31125) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2025-07-24 |