| NPI | 1548444375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 27524) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019738) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2025-06-02 |