| NPI | 1215066691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22502) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS54651) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2007-07-08 |