| NPI | 1760770143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 201957) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 055527) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2016-12-14 |