| NPI | 1336409358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021313) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19882) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2014-10-08 |