| NPI | 1376700724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20601) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 20603) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2019-07-19 |