| NPI | 1760050793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 37519) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37519) |
| 1223G0001X Dentist, General Practice (Licence: MI 2951000847) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-03-09 |