| NPI | 1568955193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MI 2901022671) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH 30.025651) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2019-02-25 |