| 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 |