| NPI | 1245228535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25082) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7922) |
| 1223G0001X Dentist, General Practice (Licence: NY 052499) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2021-02-14 |