| NPI | 1720526916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30025257) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30025257) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34834) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2019-10-25 |