| NPI | 1760582480 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 612915) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901018424) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2015-09-23 |