| NPI | 1336554484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4417) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10409) |
| 122300000X Dentist (Licence: TX 30027) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2019-03-22 |