| NPI | 1366678237 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MI 2901019668) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MI 2901019668) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2020-11-01 |