| NPI | 1104151141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00202655) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD3159) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2018-11-19 |