| NPI | 1740455583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901014455) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 3408339922) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |