| NPI | 1205018371 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901015470) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015470) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2022-09-13 |