| NPI | 1760827125 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS108657) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00201937) |
| 122300000X Dentist (Licence: TX 37031) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2023-05-31 |