| NPI | 1689167157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901022578) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025482) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2022-02-12 |