| NPI | 1699404897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 39471) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09988) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-07-22 |