| NPI | 1538421482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00201988) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2012016235) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2023-06-15 |