| NPI | 1720393846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00202980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59646) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2018-04-12 |