| NPI | 1780031179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901600693) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 21807) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2023-03-07 |