| NPI | 1720357148 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020607) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014364) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2019-06-13 |