| NPI | 1508080144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9272) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 2529) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-02-06 |