| NPI | 1184989782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858554) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28151) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2020-01-09 |