| NPI | 1194964874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29434) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3105) |
| 122300000X Dentist (Licence: CA 59209) | |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2014-09-02 |