| NPI | 1619604832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 39175) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 107724) |
| 1223G0001X Dentist, General Practice (Licence: CA 107724) | |
| Enumeration Date | 2022-08-07 |
| Last Update Date | 2023-02-22 |