| NPI | 1356500797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2952000464) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 71-000-192) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2025-08-05 |