| NPI | 1801182027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 61613) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI L2018542) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2013-12-23 |