| NPI | 1134535412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901021344) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021344) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2022-07-21 |