| NPI | 1235745357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600640) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901600640) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2022-09-15 |