| NPI | 1790180974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 30606) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6502) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2023-05-11 |