| NPI | 1801041587 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10415) |
| 1223G0001X Dentist, General Practice (Licence: MO 2008024138) | |
| Enumeration Date | 2008-11-23 |
| Last Update Date | 2021-09-15 |