| NPI | 1093897043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30760) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 011715) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-02-15 |