| NPI | 1356862593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022338) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901022338) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-02-02 |