| NPI | 1093454597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205146) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 40392) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2026-03-27 |