| 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 |