| NPI | 1811429905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32785) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61175) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2018-03-17 |