| NPI | 1093196511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010457) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.024513) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2025-02-03 |