| NPI | 1811506322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38371) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11270) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2023-08-22 |