| NPI | 1558945881 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6000031-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600852) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2022-07-08 |