| NPI | 1740202928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2750) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2015-09-21 |