| NPI | 1205186814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203799) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28329) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2021-08-10 |