| NPI | 1972624054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8633) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2015-02-17 |