| NPI | 1629223367 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: AZ 7676) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: TX 16963) |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2008-11-21 |