| NPI | 1801448964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 37400) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-08-22 |