| NPI | 1275062465 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00204176) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33004) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2019-10-29 |