| NPI | 1801209374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TX 32285) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3401) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2017-01-03 |