| NPI | 1780055483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35804) |
| Additional Taxonomies | 122300000X Dentist (Licence: ZZ 09 06949 00) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2024-10-02 |