| NPI | 1609188259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 0025624) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 0025624) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2017-02-13 |