| NPI | 1851723225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9388) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022811) |
| 1223G0001X Dentist General Practice (Licence: MI 2901022811) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2021-12-09 |