| NPI | 1225408701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601964) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6683) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2024-01-10 |