| NPI | 1962626853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22148) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 22148) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-08-01 |