| NPI | 1184827594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901019476) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054657-1) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2019-07-29 |