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 |