| NPI | 1295414274 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D15191) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2951000940) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-10-03 |