| NPI | 1316396203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60989074) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021937) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2020-12-15 |