| NPI | 1053627562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27941) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6053) |
| 1223G0001X Dentist, General Practice (Licence: GA DN013913) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2014-07-03 |