| NPI | 1780036376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 34245) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001393) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2019-02-07 |