| NPI | 1164089728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 104852) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35025) |
| 1223G0001X Dentist, General Practice (Licence: NC 14661) | |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2026-07-09 |