| NPI | 1558762401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29399) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: OR D10062) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-09-10 |