| NPI | 1174079289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33688) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100783) |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2021-05-23 |