| NPI | 1881075737 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MI 2901021578) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021578) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901021578) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-08-10 |