| NPI | 1730870072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901601801) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.028305) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2026-02-04 |