| NPI | 1942733704 |
|---|---|
| Former Name | MARY KATHLEEN GRAHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OH 30.025602) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 10167) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2019-11-23 |