| NPI | 1083098198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022354) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00202587) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2020-09-09 |