| NPI | 1942628250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MI 2901021773) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30.024693) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2016-10-10 |