| NPI | 1790918159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX #24973) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24973) |
| 1223G0001X Dentist, General Practice (Licence: TX 24973) | |
| 124Q00000X Dental Hygienist (Licence: TX 11571) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2019-03-07 |