| NPI | 1225318215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28520) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 55759) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2014-10-08 |