| NPI | 1073093670 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 34221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 103060) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2021-07-06 |