| NPI | 1891939542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25354) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS037758) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2010-07-21 |