| NPI | 1508956640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00205006) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 16152) |
| 1223G0001X Dentist, General Practice (Licence: TX 16152) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-03-09 |