| NPI | 1528614294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36796) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104266) |
| Enumeration Date | 2019-08-17 |
| Last Update Date | 2020-11-12 |