| NPI | 1497098974 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204303) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 059671) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2020-08-11 |