| NPI | 1437562246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416828) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3451) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-11-03 |