| NPI | 1790076198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-023802) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-023802) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2020-05-19 |