| NPI | 1760868657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: CA 102587) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 3621) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2021-12-01 |