| NPI | 1982746046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CO 10151) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 22248) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-05-15 |