| NPI | 1306048194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI FT1101980) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019574) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2018-03-17 |