| NPI | 1962019984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D011588) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH RES.004246) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2023-05-10 |