| NPI | 1033561329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: DC DEN1002020) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021982) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2020-03-03 |