| NPI | 1053752204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 64278) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 29254) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2015-02-05 |