| NPI | 1902101256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 34765) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413148) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2022-08-03 |