| NPI | 1457888984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KY 10392) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 003821) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2020-03-02 |