| NPI | 1619177060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00203404) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 9502) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056023) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2021-04-22 |