| NPI | 1477983864 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.028158) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021119) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2025-09-26 |