| NPI | 1255566634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14367) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2013-03-04 |