| NPI | 1104230838 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32105) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63372) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2016-11-02 |