| NPI | 1710392519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25388) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: TX CERTIFICATE) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-09-02 |