| NPI | 1629048160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 48512) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 20454) |
| 122300000X Dentist (Licence: GA DN012747) | |
| 122300000X Dentist (Licence: VA 0401410993) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |