| NPI | 1760050108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN00205382) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-10064) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30612) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-13 |
| Last Update Date | 2024-03-05 |