| NPI | 1962609305 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 30022723) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019027278) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-05-08 |