| NPI | 1902446842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 36069) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00204258) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2024-05-21 |