| NPI | 1124395108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 40150) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX F-24279) |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2014-09-12 |