| NPI | 1265520829 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 25029) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NE 6664) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-04-30 |