| NPI | 1205130168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1161790) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2011-11-27 |