| NPI | 1902418726 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 00204501) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204501) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2023-04-01 |