| NPI | 1598141855 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 64707) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34959) |
| 1223G0001X Dentist, General Practice (Licence: TX 34959) | |
| Enumeration Date | 2015-08-09 |
| Last Update Date | 2023-10-29 |