| NPI | 1780012476 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61157994) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856315) |
| 122300000X Dentist (Licence: MI 2901021055) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2021-08-10 |