NPI | 1912569815 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36176) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 36176) |
1223G0001X Dentist, General Practice (Licence: FL 24347) | |
Enumeration Date | 2019-07-01 |
Last Update Date | 2022-07-18 |