| NPI | 1003579145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901601302) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37846) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2023-04-13 |