| NPI | 1952813727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901602780) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060687) |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2025-08-26 |