| NPI | 1922250992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 25243) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57281) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2012-05-16 |