| NPI | 1386168946 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 33271) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022408) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2021-10-08 |