| NPI | 1407121262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00203851) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS020463L) |
| 122300000X Dentist (Licence: TX 30890) | |
| 122300000X Dentist (Licence: NY 057685) | |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2022-07-21 |