| NPI | 1528426558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10808) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025075) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2018-07-09 |