| NPI | 1639521404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 100221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH RES.004134) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2019-06-15 |