| NPI | 1376852244 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901020576) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 018001766) |
| 1223P0300X Dentist, Periodontics (Licence: WI 1000979) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2018-03-17 |