| NPI | 1568035301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38239) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 106671) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2026-07-25 |