| NPI | 1164401915 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 3890) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OH OH21972) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2011-01-21 |