| NPI | 1952568495 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MI 2901019867) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019867) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2010-07-21 |