| NPI | 1710486865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.025690) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025690) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.025690) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.025690) | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2022-11-22 |