| NPI | 1134650971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 10367) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021798) |
| 1223P0700X Dentist, Prosthodontics (Licence: MI 2901021798) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2020-06-04 |