| NPI | 1386672673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27682) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12237) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-09-12 |