| NPI | 1104026624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901019629) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MI 2901019629) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2012-11-09 |