| NPI | 1356739221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30472) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021817) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2021-04-21 |