| NPI | 1366728529 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00201870) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61103) |
| 1223G0001X Dentist, General Practice (Licence: TN DS0000009174) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2014-03-24 |