| NPI | 1770848012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO DEN.00203708) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60300419) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2019-10-15 |