| NPI | 1639341738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22994) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D7475) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2010-06-09 |