| NPI | 1467846055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022538) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6717) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2021-11-22 |