| NPI | 1538538657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 138815) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 138815-9922) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-18 |