NPI | 1144602608 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA 103714) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021605) |
Enumeration Date | 2015-06-22 |
Last Update Date | 2019-10-30 |