| NPI | 1598011231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901022798) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023771) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2023-12-06 |