| NPI | 1972816304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29687) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8977) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2014-03-11 |