| NPI | 1972163152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35199) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 24141) |
| 1223G0001X Dentist, General Practice (Licence: FL 24141) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-04-13 |