| NPI | 1700238821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33545) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022029) |
| 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.6097283) | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2021-01-28 |