| NPI | 1619288313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 28803) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59406) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2013-10-29 |