| NPI | 1508845728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901016874) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005039RX) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2017-10-05 |