| NPI | 1780801969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22200) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57500) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2013-01-21 |