| NPI | 1174147680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015999) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025851) |
| Enumeration Date | 2020-05-31 |
| Last Update Date | 2020-05-31 |