| NPI | 1255478194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-021084) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3436) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |