| NPI | 1619176435 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 22569) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30022569) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2020-03-11 |