| NPI | 1518487214 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 003894) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 003894) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |