| NPI | 1770573594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21968) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 21968) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2019-06-11 |