| NPI | 1477790202 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24218) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2009-01-15 |