| NPI | 1851024111 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MI 2901602783) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004523) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-08-08 |