| NPI | 1891135802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30024152) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.3344) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2022-03-25 |