| NPI | 1144658360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33366) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN20468) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901021111) | |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2017-07-25 |