| NPI | 1871841916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601174) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414237) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2023-02-10 |