| NPI | 1508159484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00202777) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24873) |
| 1223P0300X Dentist, Periodontics (Licence: TX 24873) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2018-08-04 |