| NPI | 1780995043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020257) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020257) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2022-04-20 |