| NPI | 1831456359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 00202377) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023666) |
| Enumeration Date | 2012-04-22 |
| Last Update Date | 2022-11-07 |