| NPI | 1588811632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.023865) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6300-015) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2021-07-28 |