| NPI | 1750059432 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 37654) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 37654) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-09-01 |