| NPI | 1780772517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22899) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0022899) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2019-10-18 |