| NPI | 1386767267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901022816) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 49945) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401413874) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2021-10-01 |