| NPI | 1700322716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00203127) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 21278) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-06-08 |