| NPI | 1053561043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN00010227) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD3122) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2016-06-07 |