| NPI | 1316371305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-024010) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4204) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2019-10-15 |