| NPI | 1912388075 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 32863) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 11415) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2023-01-15 |