| NPI | 1841676822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 29010211560) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 5315071562) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2021-09-10 |