| NPI | 1891179529 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33124) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021624) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2020-11-12 |