| NPI | 1053763771 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857797) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022011) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2018-03-17 |