| NPI | 1053822817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025367) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.003907) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2026-05-15 |