| NPI | 1124381298 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29655) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020720) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2018-03-29 |