| NPI | 1962856518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33726) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059282) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2019-01-04 |