| NPI | 1073846408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015253) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023118) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2019-03-02 |