| NPI | 1386176444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901601278) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MA DL13101) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2023-06-05 |