| NPI | 1902782691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 41905) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: TX 41905) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |