| NPI | 1083001945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.026298) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 058518) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60778730) | |
| Enumeration Date | 2015-04-18 |
| Last Update Date | 2021-06-21 |