| NPI | 1700042165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021822) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10184) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2022-07-21 |