| NPI | 1679764021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00202711) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60494) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2020-12-30 |