| NPI | 1962681882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901020603) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MI 2901020603) |
| Enumeration Date | 2007-10-27 |
| Last Update Date | 2020-02-18 |