| NPI | 1063691822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-019068) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-022396) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2007-10-29 |