| NPI | 1063769594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD4402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020723) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2016-06-07 |