| NPI | 1275757486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 17890) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00008259) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2023-03-07 |