| NPI | 1588734917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25083) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2001031632) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2011-04-06 |