| NPI | 1588299911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2951000978) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 062152) |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2024-06-30 |