| NPI | 1235451881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 27180) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054796) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2011-10-24 |