| NPI | 1730777699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 107460) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61167850) |
| 1223G0001X Dentist, General Practice (Licence: TX 36644) | |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2022-05-27 |