| NPI | 1649706391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 103679) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.025517) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2019-09-10 |