| NPI | 1760868814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN122539) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS100405) |
| 122300000X Dentist (Licence: OH 30.024573) | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2022-02-16 |