| NPI | 1366659658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OH 2536) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901018436) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-10-29 |