| NPI | 1649700089 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MD 17610) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CO 00203190) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2023-10-16 |