| NPI | 1659871945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 104736) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.025474) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.025474) | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2021-08-16 |