| NPI | 1053628255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00010007) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10303) |
| 122300000X Dentist (Licence: GA DN015374) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2018-03-17 |