| NPI | 1346374840 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 38425) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018813) |
| 1223G0001X Dentist General Practice (Licence: MI 2901018813) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-06-16 |