| NPI | 1285691832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2004023240) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM DD2650) |
| 1223G0001X Dentist General Practice (Licence: TX 23515) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2012-06-25 |