| NPI | 1619298874 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901020873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 6527) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901020873) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2024-03-27 |