| NPI | 1487094728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00202312) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 12398) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2019-01-04 |