| NPI | 1669812673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9575) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901022466) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2020-02-11 |