| NPI | 1285909598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 27785) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 10680) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2017-07-12 |