| NPI | 1548318652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601270) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 71-000197) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-05-16 |