| NPI | 1275024192 |
|---|---|
| Former Name | BRIANNE ELIZABETH NEELIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901022635) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MI 2901022635) |
| Enumeration Date | 2018-05-26 |
| Last Update Date | 2019-10-01 |