| NPI | 1053400309 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3669) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022488) |
| 1223G0001X Dentist, General Practice (Licence: PA DS036509) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-01-06 |