| NPI | 1114417474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2951000446) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901022753) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2022-06-28 |