| 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 |