NPI | 1134650971 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KY 10367) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021798) |
1223P0700X Dentist, Prosthodontics (Licence: MI 2901021798) | |
Enumeration Date | 2017-03-23 |
Last Update Date | 2020-06-04 |