| NPI | 1811511470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36840) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7054-PR) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2021-11-07 |