| NPI | 1265712590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023457) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0442000170) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2013-06-25 |