| 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 |