| NPI | 1518296482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: TX 36893) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: LA 6794) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2023-03-21 |