| NPI | 1124436878 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 104504) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 30197) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2021-03-04 |