| NPI | 1518057652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857437) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX F21892) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2016-12-29 |