| NPI | 1679893713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203141) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6654-15) |
| 1223G0001X Dentist, General Practice (Licence: NM DD4233) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2020-03-19 |