| NPI | 1700045002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412792) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 2710) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2010-12-28 |