| NPI | 1710249651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD.8108 GD) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020704) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2014-11-07 |