| NPI | 1104040666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 1496) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2020-02-04 |