| NPI | 1881029650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN00203814) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039648) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2019-05-21 |