| NPI | 1407181332 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25421) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3891) |
| 122300000X Dentist (Licence: PA DS038088) | |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2010-12-08 |