| NPI | 1700040888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56715) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25578) |
| 122300000X Dentist (Licence: NM 4196) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2014-11-07 |