| NPI | 1659851384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 204861) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858104) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2022-11-06 |