| NPI | 1316380835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO den.00203471) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8708209-9922) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2018-04-27 |