| NPI | 1477703304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 57691) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025643) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2019-02-06 |