| NPI | 1104233451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 1857167) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 29718) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2016-06-04 |