NPI | 1205191590 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901020433) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020433) |
Enumeration Date | 2012-07-12 |
Last Update Date | 2021-10-22 |