| NPI | 1023679222 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 105776) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025885) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2021-01-25 |