| NPI | 1013379890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021651) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26725) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-08-26 |