| NPI | 1780084525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33636) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014028197) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2021-03-10 |