| NPI | 1588957187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901020800) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020800) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2021-04-21 |