| NPI | 1841805454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 40374) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: UT 11703587-9922) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2024-10-22 |