| NPI | 1154603348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 204400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 60827) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2021-09-28 |