| NPI | 1699042655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 10704) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9121) |
| 122300000X Dentist (Licence: TX 24179) | |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2012-10-02 |