| NPI | 1881755205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30-022516) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 048219-1) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2016-02-17 |