| NPI | 1275970345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9497) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901020933) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-01-18 |