| NPI | 1053475681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38189) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050222) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-03-21 |