| NPI | 1386052561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901021226) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024298) |
| 122300000X Dentist (Licence: OR D11249) | |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2024-06-17 |