| NPI | 1972745313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 25711) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54917) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2012-02-02 |