| NPI | 1104077429 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27340) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054061-1) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2018-07-03 |