| NPI | 1689095150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30168) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056997-1) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2016-09-12 |