| NPI | 1811258221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MI 2901020659) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020659) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2015-07-20 |