| NPI | 1679561716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD2274) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: NM DD2274) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2007-07-08 |