| NPI | 1417483223 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600420) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-100848) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-06-22 |