| NPI | 1801912324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 23804) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 21741) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-08-28 |