| NPI | 1558024810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist Prosthodontics (Licence: MI 2952000774) |
| Additional Taxonomies | 1223P0700X Dentist Prosthodontics (Licence: MI 2952000774APP21) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2022-04-21 |