| NPI | 1306576632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 11011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901601390) |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2023-07-18 |