| NPI | 1962411827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: CO DEN.00105371) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 17951) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OH 30-024363) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30-024363) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2019-06-18 |