| NPI | 1679141444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 211779) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2951000871) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2023-08-07 |