| NPI | 1912365396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32665) |
| Additional Taxonomies | 1223X0008X Dentist, Oral and Maxillofacial Radiology (Licence: FL DRP1369) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2021-07-27 |