| NPI | 1710387261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D14351) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-024383) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2021-11-02 |