| NPI | 1477048411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600971) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001847-15) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-10-18 |