| NPI | 1912493057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901022948) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041792) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2019-08-10 |