| NPI | 1245594589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 28602) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020698) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2015-02-26 |