| NPI | 1760507289 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9646) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 05278-1) |
| 1223G0001X Dentist, General Practice (Licence: CO 9646) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-06-21 |