| NPI | 1801990502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: IA 07334) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 18573) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |