| NPI | 1508319153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 103615) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 32079) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2019-05-02 |