| NPI | 1093045627 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 27252) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020074) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2012-04-25 |