| NPI | 1639643539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO den00204246) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022914) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2023-11-14 |