| NPI | 1770996399 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901022485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4095) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2018-03-17 |