| NPI | 1366227118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901601905) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901601905) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2023-08-29 |