| NPI | 1407237985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 35895) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021532) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-05-05 |