| NPI | 1386026946 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 202540) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2015016763) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2016-06-16 |