| NPI | 1457735482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022527) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 64768) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2022-06-07 |