| NPI | 1114309986 |
|---|---|
| Former Name | SUSAN WOFFORD HIMSCHOOT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9716) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013505A) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-11-03 |