| NPI | 1811075153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22979) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 60993) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2012-03-07 |