| NPI | 1962855387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901021960) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 21960) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2017-10-13 |