| NPI | 1568635480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61038) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 17977) |
| 122300000X Dentist (Licence: TX 24452) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2011-12-02 |