| NPI | 1245123843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 14781) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004951) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.004951) | |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2026-09-10 |