| NPI | 1992868996 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1427) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 17836) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2016-12-29 |