| NPI | 1558679175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN00204177) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60169108) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2022-11-22 |