| NPI | 1780807578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 00204680) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022216L) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2022-05-10 |