| NPI | 1689025470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901601546) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 33898) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-07-25 |