| NPI | 1346619657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10320) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600121) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2022-09-22 |