NPI | 1619397999 |
---|---|
Former Name | JESSICA CHRZANOWSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.024596) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2014-04-24 |
Last Update Date | 2021-01-25 |