| NPI | 1003000654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26299) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 55219) |
| 1223G0001X Dentist, General Practice (Licence: MS 3531-09) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2011-06-10 |