| NPI | 1558658955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024684) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL11302) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-02-01 |