| NPI | 1194981779 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 203411) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053973) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2021-05-20 |