| NPI | 1154843563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30025572) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041388) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2020-02-12 |