| NPI | 1063620169 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE00006771) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30-01-8319) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-08 |