| NPI | 1801308150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901600670) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13483) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2020-09-04 |