| NPI | 1801456173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 34376) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34376) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-03-17 |