| NPI | 1760617120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 08785) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 24372) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2014-03-10 |