| NPI | 1144810011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2951000875) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026356) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2951000875) | |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2022-06-29 |