| NPI | 1679906622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00202088) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 30801) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2016-08-15 |