| NPI | 1215445648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060933) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901600399) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901022483) | |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2023-07-27 |