| NPI | 1417496548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00203509) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 021440139) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2018-10-30 |