| NPI | 1205236353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00204401) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15694) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2020-08-24 |