| NPI | 1326474230 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN00202101) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014705) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2019-06-17 |