| NPI | 1932636107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 33457) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901022185) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2020-09-01 |