| NPI | 1063757623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 30384) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901020851) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901020851) | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2017-01-10 |