| NPI | 1467697714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 23018) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 5349) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2020-06-17 |