| NPI | 1174827885 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63096) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 26108) |
| 1223G0001X Dentist, General Practice (Licence: IL 019.028600) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2014-01-28 |