| NPI | 1447572011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.023804) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019028251) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2020-12-09 |