| NPI | 1194188672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 202766) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202766) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-12-18 |