| NPI | 1679515696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 44021) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 44021) |
| 1223G0001X Dentist, General Practice (Licence: TX 21967) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-03-02 |