| NPI | 1780104562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010312) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 33135) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2019-06-04 |