| NPI | 1760863583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203022) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: GA DN014984) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-09-04 |