| 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 |