| NPI | 1326531658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 106090) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH 30.024640) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.024640) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-04-06 |