| NPI | 1235590415 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025929) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OH 30.025929) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 1223G0001X Dentist General Practice (Licence: NY 059415-1) | |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2020-06-09 |