| NPI | 1316910763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MI 2901018319) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D11710) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2022-10-03 |