| NPI | 1528171683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901016802) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 16802) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-08-01 |