| NPI | 1639734494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601205) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 12821) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2022-09-14 |