| NPI | 1376838524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: IA 40163) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MI 2901020345) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2018-05-31 |