| NPI | 1003034372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22845) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TX 22845) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2008-05-16 |