| NPI | 1063672236 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9798) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 2618) |
| 122300000X Dentist (Licence: OH 30-022876) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2016-09-07 |