| NPI | 1700248523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36046) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6693) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-08-20 |