| NPI | 1770925836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 29233) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64296) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2015-02-24 |