| NPI | 1770322760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 42405) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.027477) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2026-07-05 |