| NPI | 1417038613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26089) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 54675) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-04-18 |