| NPI | 1669549531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901017124) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 17124) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-11-26 |