| NPI | 1689969909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28463) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020484) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2012-09-26 |