| NPI | 1376934802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 31957) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN00202436) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2020-02-05 |