| NPI | 1154060846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00205412) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122754) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-11-14 |