NPI | 1417474321 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 36061) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 104195) |
1223G0001X Dentist, General Practice (Licence: MI 2901022424) | |
Enumeration Date | 2017-08-23 |
Last Update Date | 2022-03-05 |