| NPI | 1417007568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016231) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 19496 OH) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-09-11 |