| NPI | 1861971616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105876) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022750) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2021-01-04 |