| NPI | 1679954010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901018716) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 5315015589) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |