| NPI | 1366604449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26071) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD 34 04) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2012-09-13 |