| NPI | 1154412351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203765) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 20203) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2019-02-11 |