| NPI | 1538457031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020392) |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain (Licence: MI 2901020392) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2019-10-04 |