| NPI | 1083844328 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00203133) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412579) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2019-04-01 |