| NPI | 1760124754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901602028) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN27599) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2025-09-18 |