| NPI | 1255343075 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901022863) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 00132) |
| 1223G0001X Dentist, General Practice (Licence: NY 047799) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-09-30 |