| NPI | 1487860862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 14709) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411043) |
| 122300000X Dentist (Licence: TX 23631) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-08-26 |