NPI | 1609163773 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60575899) |
Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020427) |
Enumeration Date | 2011-07-08 |
Last Update Date | 2018-03-17 |