| NPI | 1790332575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D010372) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025961) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2021-11-09 |