| NPI | 1770867020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 20392) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA DDS 49187) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |