| NPI | 1588090831 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00202801) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 1856312) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2016-11-18 |