| NPI | 1912988163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30.024762) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-002308) |
| 122300000X Dentist (Licence: OH Res3745) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-12-02 |