| NPI | 1912510645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.027057) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600575) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2023-11-17 |