| NPI | 1558569301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30022490) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019117) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |