| NPI | 1164442596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.022961) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3950) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2017-10-13 |