| NPI | 1639261340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.025571) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 17077) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-10-08 |