| NPI | 1801204292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 30536) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 09224) |
| 1223G0001X Dentist General Practice (Licence: CA DDS63691) | |
| 1223G0001X Dentist General Practice (Licence: IL 019.030471) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2017-11-21 |