| NPI | 1154701969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901022161) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.24833) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2018-08-20 |