| NPI | 1326485079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022129) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024253) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2020-12-17 |