| NPI | 1508460742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 105220) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 40831) |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2025-09-05 |