| NPI | 1457575714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NM dd2048) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017490) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2019-07-05 |