| NPI | 1861876005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2016017018) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021657) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2017-03-22 |