| NPI | 1053768978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022958) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20597) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2021-09-10 |