NPI | 1740697705 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600144) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22D102576700) |
Enumeration Date | 2014-07-22 |
Last Update Date | 2020-05-15 |