NPI | 1780138222 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 06012) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30.24864) |
1223G0001X Dentist, General Practice (Licence: MI 2901022056) | |
1223G0001X Dentist, General Practice (Licence: NY 06012) | |
Enumeration Date | 2016-08-13 |
Last Update Date | 2019-10-10 |