| NPI | 1710244256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 26073) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN18070) |
| 1223P0300X Dentist, Periodontics (Licence: CA 56812) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2016-10-26 |