| NPI | 1972028769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33412) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101895) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2021-04-02 |