| NPI | 1497974638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-018866) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-01-8866) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2018-10-23 |