| NPI | 1831194414 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10110) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 14071) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2010-03-22 |