| NPI | 1972023661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32945) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32945) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-01-15 |