| NPI | 1376975144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901021024) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901021024) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2023-04-05 |