| NPI | 1902168602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 30809) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2022-07-21 |