| NPI | 1760793277 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: TX TX29842) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 29842) |
| 122300000X Dentist (Licence: FL 18650) | |
| 1223P0700X Dentist, Prosthodontics (Licence: FL DN18650) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2018-12-10 |