| NPI | 1215594346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 107128) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 107128) |
| 122300000X Dentist (Licence: CO 00205284) | |
| 122300000X Dentist (Licence: FL DN27541) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-10-06 |