| NPI | 1710214200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25092) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25092) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2016-09-07 |