| NPI | 1467533968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 056037-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901012312) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2015-10-02 |