| NPI | 1477832152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021099) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 60745) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2014-07-31 |