| NPI | 1487175402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 61474) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN00203295) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2019-06-13 |