NPI | 1588191738 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 104960) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
1223G0001X Dentist General Practice (Licence: MI 2901022403) | |
Enumeration Date | 2017-05-18 |
Last Update Date | 2020-09-04 |