| NPI | 1235786013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010374) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025964) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2021-11-15 |