| NPI | 1053625079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2013043437) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020277) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2021-09-30 |