| NPI | 1114135548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: DC DEN1000851) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019380) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-03-04 |