| NPI | 1588813802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 24391) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57645) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2012-08-14 |