| NPI | 1639731995 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35369) |
| Enumeration Date | 2019-07-07 |
| Last Update Date | 2024-01-09 |