| NPI | 1457573743 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI D18270) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12639) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2026-01-20 |