| NPI | 1578716254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27956) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054693) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2012-09-06 |