| NPI | 1770712317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33531) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055216) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2022-07-19 |