| NPI | 1760558258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN00201866) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17435) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2014-04-10 |