| NPI | 1144499906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 27504) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019742) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2016-09-12 |