| NPI | 1306170196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 58933) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 24861) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2015-11-06 |