| NPI | 1992191415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901021553) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019030607) |
| 1223G0001X Dentist, General Practice (Licence: NC 11432) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 018001941) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2020-04-16 |