| NPI | 1770075608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 106559) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 33953) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2022-01-07 |