| NPI | 1982863585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 8211338-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD2990) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2020-05-13 |