| NPI | 1578673935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 29176) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 55824) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D8011) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-04-17 |