| NPI | 1063070233 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.026862) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901023224) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-07-25 |