| NPI | 1073167904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601095) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17051) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2022-01-03 |