| NPI | 1205189719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NM DD4420) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 59915) |
| 1223P0300X Dentist, Periodontics (Licence: CO Den.00202055) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2021-12-08 |