| NPI | 1700555190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37804) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7221) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2023-04-30 |