| NPI | 1184851925 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO D9936) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 9936) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12915) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2014-09-17 |