| NPI | 1518272962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 04701415394) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020077) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2018-03-20 |