| NPI | 1841578820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 27270) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001128-15) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-10-05 |