| NPI | 1316229347 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD4454) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 27451) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2016-03-17 |