| NPI | 1184611030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 9990) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 21192) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2009-12-15 |