| NPI | 1932483567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CO 00010486) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN 10486) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2019-01-03 |