| NPI | 1982075586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414908) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022096) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2017-02-03 |