| NPI | 1558550954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 64257) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019713) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2022-05-24 |