| NPI | 1588894240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 28673) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA 10541) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2022-09-19 |