| NPI | 1467826578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704226214) |
| Additional Taxonomies | 125K00000X Advanced Practice Dental Therapist (Licence: MI 4704226214) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2019-06-10 |