| NPI | 1124010343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 18257) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 15912) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-07-08 |