| NPI | 1558529149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019934) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30022833) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2010-01-21 |