| NPI | 1831690072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901601873) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09569) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2023-12-21 |