| NPI | 1386602365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 20930) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401410224) |
| 122300000X Dentist (Licence: NC 7383) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2008-02-15 |