| NPI | 1437574589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021807) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02538401) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2017-02-14 |