| NPI | 1073825006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IA 08869) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020238) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2012-01-18 |