| NPI | 1760660674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 22348) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 55495) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2014-03-19 |