| NPI | 1790352698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 11399) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004373) |
| 122300000X Dentist (Licence: OH 30.026768) | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2025-11-04 |