| NPI | 1023562048 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857919) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022015) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2022-12-27 |