| NPI | 1548751092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00205461) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12307) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2023-09-25 |