| NPI | 1194810788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 0026082) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012453) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-05-08 |