| NPI | 1578282067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DENT.DE.61327761) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601519) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2026-03-31 |