| NPI | 1114331865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00202658) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63400) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2015-09-29 |