| NPI | 1770739146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57143) |
| Enumeration Date | 2008-08-17 |
| Last Update Date | 2015-05-26 |