| NPI | 1801087135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 24818) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401411768) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2013-11-29 |