| NPI | 1164762175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30841) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15501) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2016-06-23 |