NPI | 1811202831 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: TX 25863) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 25863) |
Enumeration Date | 2010-08-13 |
Last Update Date | 2013-11-13 |