| NPI | 1619126943 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57464) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28774) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CA 1535) | |
| 1223G0001X Dentist, General Practice (Licence: TX 28774) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2021-09-12 |