| NPI | 1790090462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30464) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59661) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2017-05-03 |