| NPI | 1972818524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31558) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60171753) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2016-02-19 |