| NPI | 1316456858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33516) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CO DEN.00204013) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2023-05-16 |