| NPI | 1790386779 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901601556) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901601556) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 36833) | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2026-02-10 |