| NPI | 1346464179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019226) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 22140) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2008-12-09 |