| NPI | 1225047483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 260057) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63019) |
| 122300000X Dentist (Licence: MI 2901018407) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-08-20 |