| NPI | 1003044025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 27615) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1855158) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2021-02-19 |