| NPI | 1245769736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901022244) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022244) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-01-03 |