| NPI | 1801925920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22482) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2002001254) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-03-25 |