| NPI | 1376868679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 29611) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 29611) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2014-10-20 |