| NPI | 1063147437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026956) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 600001315) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2024-10-03 |