| NPI | 1073630372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26374) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08454) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2014-02-10 |