| NPI | 1700411733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40260) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600410) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2024-05-02 |