| NPI | 1740964410 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 122300000X Dentist (Licence: CA 110038) | 
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.027245) | 
| Enumeration Date | 2023-06-13 | 
| Last Update Date | 2025-06-23 |