| NPI | 1790126779 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31791) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31791) |
| 122300000X Dentist (Licence: NY 057614) | |
| 122300000X Dentist (Licence: PA DS040753) | |
| 122300000X Dentist (Licence: MA DL11947) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2020-06-21 |