| NPI | 1518633171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13106) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600997) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2024-05-20 |