| NPI | 1174959928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10844) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201392657NP-PP) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2018-07-31 |