| NPI | 1104811579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 24166) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 6959) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2012-06-07 |