| NPI | 1780975763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28025) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8400016-9921) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2012-09-20 |