| NPI | 1124567292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901600784) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060623) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2021-06-29 |