| NPI | 1528121332 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25084) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17776) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2016-09-05 |