| NPI | 1972816031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61205) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0025804) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2021-12-01 |