| NPI | 1366744930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX UTSA920-X) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2019-06-04 |