| NPI | 1063791366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29708) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855824) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2020-01-31 |