| NPI | 1316594740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CO DEN00205847) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60970413) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2024-07-25 |