| NPI | 1063086171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA DDS108273) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.026481) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2025-06-09 |