| NPI | 1811410616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018016757) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33318) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2018-10-02 |