| NPI | 1760777437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26423) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 26423) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 26423) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-08-30 |