| NPI | 1073674123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22265) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22265) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-11-04 |