| NPI | 1215126610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901018360) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018360) |
| 1223E0200X Dentist Endodontics (Licence: MI 2901018360) | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2022-08-03 |