| NPI | 1346362035 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 16908) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 41613) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-10-01 |