| NPI | 1639722960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600235) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN26436) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2021-09-07 |