| NPI | 1376899872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23305) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021104) |
| 122300000X Dentist (Licence: MA DL11561) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2018-07-03 |