| NPI | 1831454602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NM DD4146) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 28076) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2014-08-04 |